Therapeutic Touch

PEP Topic

Anxiety

Description

Therapeutic touch (TT) or healing touch is an energy therapy where the practitioner’s hands move through the patient’s energy field to assess and treat energy field imbalances (Shames & Keegan, 2000). The specially trained practitioner deliberately “centers” intention from an external focus to an internal focus of calm, then moves his or her hands over the patient’s body, but does not actually touch the body. Therapeutic touch has been studied as an intervention of anxiety and pain in patients with cancer.

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment

APPLICATIONS: Palliative care

Results:

Interventions considered to be BT were healing touch, Reiki, and therapeutic touch. The effect on pain was examined in seven studies. There were some mixed findings, but most showed a reduction in pain over short time periods. Fatigue was assessed in five studies. These demonstrated fatigue reduction post-treatment, but data were conflicting over a longer period of four to eight weeks. Anxiety and depression were examined in seven studies. All but one found a significant reduction in mood disorders, but a study comparing Reiki, sham Reiki, and usual care found no difference between the sham and actual Reiki groups. Most studies were of descriptive or quasi-experimental design; potential confounding variables were not examined, and placebo effects could not be ruled out.

Conclusions:

Studies using biofield therapies for relief of pain, anxiety, fatigue, and depression generally showed benefit; however, the evidence is not strong due to the limitations of the studies included.

Limitations:

Low-quality design studies and the short duration of study follow-up

Nursing Implications:

BT therapies have not demonstrated effectiveness in well-designed clinical studies; however, though it is weak, evidence suggests potential benefit. There were no adverse effects of these interventions reported. Biofield therapies are not expensive and are low-risk, so they can be considered in the management of cancer-related symptoms. Well-designed clinical trials are needed to establish efficacy.

Intervention Characteristics/Basic Study Process:

This intervention was therapeutic touch (TT). The experimental group received 10 minutes of TT and 20 minutes of dialogue, and the control group received 10 minutes of quiet time and 20 minutes of dialogue. Data were collected as part of a larger experimental study of the effects of TT on pre- and postoperative anxiety and mood and pain in women with breast cancer. Telephone interviews were conducted at the completion of an experimental or control nursing intervention administered in the women’s homes before and after breast cancer surgery. The interview consisted of six open-ended questions.

Sample Characteristics:

The study reported on a sample of 18 women with early-stage breast cancer.

Study Design:

Mixed methods of qualitative and quantitative study were used.

Measurement Instruments/Methods:

Telephone interviews consisting of six open-ended questions

Results:

Regardless of experimental or control intervention, women expressed feelings of calmness, relaxation, security, and comfort. No objective measures were reported.

Study Purpose:

To determine if massage therapy and healing touch were effective in reducing anxiety, mood disturbance, pain, fatigue, and nausea and in improving the relaxation and satisfaction with care of patients receiving chemotherapy treatment

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to one of three groups: therapeutic massage, healing touch, or caring presence. All received four weekly 45-minute sessions of the intervention and four weeks of standard care (control). After four weeks, patients were crossed over to another intervention or the control. Order of the intervention and usual-care control were randomized. Pre- and post-assessments of pain, nausea, and vital signs were done at each session. Assessments of intervention effects were done at the beginning and end of each four-week session. Therapeutic massage was provided in a standardized fashion, using a Swedish massage protocol. Healing touch followed a previously developed protocol incorporating centering, unruffling, magnetic unruffling, full-body connection, mind clearing, chelation, and lymphatic drain. Presence consisted of patients lying down for 45 minutes with relaxing music and the presence of a therapist. The therapist asked patients how they were feeling and if they had any questions. Conversation may or may not have occurred, according to the patient’s preference; the purpose of the therapist was to be attentive but to avoid therapy or physical intervention. The control condition consisted of usual care, which the authors did not describe.

Sample Characteristics:

The study reported on a sample of 164 patients.

Mean patient age was 57.4 years, with a range of 27–83 years.

The sample was 87% female and 13% male.

The most common cancer types were breast, gynecologic or genitourinary, gastrointestinal, hematologic, and lung.

The majority of patients had stage III or IV disease, and 50% were in the first month of chemotherapy treatment.

All patients had a score of at least 3 on a 10-point scale of symptom severity. The most frequently reported symptoms were fatigue, pain, anxiety, and nausea.

Setting:

Single site

Outpatient setting

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

A randomized, controlled, parallel-group, crossover design was used.

Measurement Instruments/Methods:

Symptom rating scales (0–10)

Brief Pain Inventory

Brief Nausea Index

Profile of Mood States

Satisfaction measure according to a four-point Likert-type scale

Results:

Of those who initially entered the study, 29% dropped out. Half of the dropouts were due to changes in the cancer treatment protocol; half were because patients wanted an intervention different from the one assigned. Those who dropped out had higher pain, nausea, mood disturbance, and fatigue at baseline (p < 0.05) than those who did not.

Massage and healing touch groups showed immediate post-session reduction of respiratory rate, heart rate, and blood pressure (p < 0.01), and these interventions were more effective (p < 0.01) in achieving these reductions than were control and presence conditions. Massage and healing touch were associated with pre- and post-session reduction in current pain (p < 0.001).

Over the four-week study period, mood disturbance decreased over time in all patients. Massage therapy, compared to the control condition, was more effective at reducing total mood disturbance (p = 0.004) and anxiety (p = 0.023). Healing touch reduced mood disturbance (p = 0.003) and fatigue (p = 0.028).

Mean pain scores in all cases declined over time.

There were no differences between groups in nausea or use of antiemetics.

There were no differences between groups in overall satisfaction. Massage and healing touch were associated with higher satisfaction with the intervention than was presence (p < 0.0001).

Limitations:

The control condition may not have provided appropriate attentional control.

The study had risk of bias due to no blinding.

The anxiety measure was not a rigorous, valid tool; it was a 10-point scale.

The study had a large drop-out rate.

Nursing Implications:

Massage therapy and therapeutic touch can be beneficial to patients because the interventions induce physical relaxation and reduce pain, fatigue, and anxiety. In this study, these interventions were more effective in this regard than was therapeutic presence alone. Massage therapy and therapeutic touch are complementary therapies that nurses can consider and advocate for on behalf of patients who may benefit from them.